Reversible Cognitive, Motor, and Driving Impairments in Severe Hypothyroidism

Smith, Charles D.; Grondin, Richard; LeMaster, William; Martin, Barbara J.; Gold, Brian T.; Ain, Kenneth B.

doi:10.1089/thy.2014.0371

Cited by 36 publications

(27 citation statements)

References 31 publications

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“…It has been shown that circadian rhythms control sleep and biological processes including cell regeneration, core body temperature variations, and hormone metabolism (Buysse et al ., 2005; Sharma and Kavuru, 2010). There is also evidence that changes in the metabolism, especially disorders of the thyroid function, may be associated with cognitive decline (Smith et al ., 2002) and specifically decrease in speed of processing (Montalvo et al ., 2014; Smith et al ., 2015). Furthermore, changes in the thyroid, especially hypothyroidism, is considered a reversible cause of secondary dementia in older adults (Horvath et al ., 1989; Cummings, 1992).…”

Section: Discussionmentioning

confidence: 99%

Daytime somnolence as an early sign of cognitive decline in a community‐based study of older people

Tsapanou

O’Shea

et al. 2015

Int J Geriat Psychiatry

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Objective This study aimed to examine the association between self-reported sleep problems and cognitive decline in community-dwelling older people. We hypothesized that daytime somnolence predicts subsequent cognitive decline. Methods This is a longitudinal study in a 3.2-year follow-up, with 18-month intervals. The setting is the Washington Heights-Inwood Community Aging Project. There were 1098 participants, who were over 65 years old and recruited from the community. Sleep problems were estimated using five sleep categories derived from the RAND Medical Outcome Study Sleep Scale: sleep disturbance, snoring, awaken short of breath/with a headache, sleep adequacy, and daytime somnolence. Four distinct cognitive composite scores were calculated: memory, language, speed of processing, and executive functioning. We used generalized estimating equations analyses with cognitive scores as the outcome, and time, sleep categories and their interactions as the main predictors. Models were initially unadjusted and then adjusted for age, gender, education, ethnicity, depression, and apolipoprotein E-ε4 genotype. Results Increased daytime somnolence (including feeling drowsy/sleepy, having trouble staying awake, and taking naps during the day) was linked to slower speed of processing both cross-sectionally (B = −0.143, p = 0.047) and longitudinally (B = −0.003, p = 0.027). After excluding the demented participants at baseline, the results remained significant (B = −0.003, p = 0.021). Conclusions Our findings suggest that daytime somnolence may be an early sign of cognitive decline in the older population. Copyright # 2015 John Wiley & Sons, Ltd.

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Section: Discussionmentioning

confidence: 99%

Daytime somnolence as an early sign of cognitive decline in a community‐based study of older people

Tsapanou

O’Shea

et al. 2015

Int J Geriat Psychiatry

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“…Another study from the United Kingdom found that low-dose radioiodine plus thyrotropin alfa was as effective as high-dose radioiodine, with a lower rate of adverse events [4]. A recent study demonstrated reversible cognitive, motor and driving impairments in severe hypothyroidism [11]. It will be important to analyze the impact of different protocols for RAI ablation on long-term treatment outcomes, particularly recurrence rates, quality of life, and health care costs.…”

Section: Discussionmentioning

confidence: 99%

Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000–2010

Rachinsky

Rajaraman

Leslie

et al. 2016

Journal of Thyroid Research

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Background. Use of radioactive iodine (RAI) ablation has been reported to vary significantly between studies. We explored variation in RAI ablation care patterns between seven thyroid cancer treatment centers in Canada. Methods. The Canadian Collaborative Network for Cancer of the Thyroid (CANNECT) is a collaborative registry to describe and analyze patterns of care for thyroid cancer. We analyzed data from seven participating centers on RAI ablation in patients diagnosed with well-differentiated (papillary and follicular) thyroid cancer between 2000 and 2010. We compared RAI ablation protocols including indications (based on TNM staging), preparation protocols, and administered dose. We excluded patients with known distant metastases at time of RAI ablation. Results. We included 3072 patients. There were no significant differences in TNM stage over time. RAI use increased in earlier years and then declined. The fraction of patients receiving RAI varied significantly between centers, ranging between 20–85% for T1, 44–100% for T2, 58–100% for T3, and 59–100% for T4. There were significant differences in the RAI doses between centers. Finally, there was major variation in the use of thyroid hormone withdrawal or rhTSH for preparation of RAI ablation. Conclusion. Our study identified significant variation in use of RAI for ablation in patients with well-differentiated thyroid cancer both between Canadian centers and over time.

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“…The intensity of individual symptoms of iatrogenic hypothyroidism may vary from patient to patient; however, the cognitive, motor and psychological deficitslinked to severe hypothyroidism and resulting in the impaired ability to operate machinery or drive vehicles -might have been underestimated. Driving motor vehicles such as cars or motorbikes, should be avoided in the severe hypothyroid state because of decreased finemotor performance and processing speed, and slowed reaction times (braking times were increased by 8.0%, equivalent to the motor slowing caused by alcohol ingestion at a blood concentration of 0.082 g/100 ml; this concentration is above the levels allowed within EU for driving) [3]. This is quite relevant since driving habits appear to be difficult to change in at least 30% of THW cases, irrespectively of a strong negative medical advice [4].…”

Section: Cost-effectiveness Profile Of Exogenous Tsh Therapy (Thyrogementioning

confidence: 99%

“…The benefits associated with the use of Thyrogen ® include avoidance of the symptoms of hypothyroidism, which include fatigue, weakness, constipation, depression, impaired memory and bodily pain. Recently, hypothyroidism has been associated with cognitive and motor impairments that are likely to constitute hazards in the operation of motor vehicles and a public safety risk [3]. Avoidance of hypothyroidism via Thyrogen ® therapy has been found to be associated with consequent better health-related quality of life, little or no productivity loss and a reduction in the need for GP visits or medications [4].…”

mentioning

confidence: 99%

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

Danieli

Monari

Lazzarini

et al. 2016

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BACKGROUND: Radioiodine ablation is an adjuvant procedure used to treat patients with differentiated thyroid cancer. For ablation to be successful, patients must have elevated levels of thyroid stimulating hormone (TSH). This can be achieved by withholding thyroid hormone therapy (endogenous stimulation), or by administration of recombinant human thyroid stimulating hormone (rhTSH; Thyrogen®; exogenous stimulation) to patients in the euthyroid state.AIM: To compare the estimated health benefits, cost and cost-effectiveness of TSH stimulation with and without Thyrogen® in the Italian setting.METHODS: A cost-utility analysis was undertaken to assess the impact of exogenous vs. endogenous TSH stimulation before radioiodine remnant ablation of patients with newly diagnosed, well-differentiated papillary or follicular thyroid cancer who have undergone total or near-total thyroidectomy. A Markov model was developed to simulate treatment costs and health outcomes associated with exogenous and endogenous stimulation in four distinct health states: pre-ablation, ablation, post-ablation, and well/recovery. Treatment was stratified by patients who receive high- and low-activity (30-100 mCi, respectively) in the ablation state. The Italian National Health System perspective was adopted in the base case scenario while the impact of indirect costs was explored in a sensitivity analysis. Costs and quality-adjusted life years (QALY) specific to each health state were estimated, summarized and converted into a corresponding incremental cost-effectiveness ratio (ICER).RESULTS: We calculated a cost-effectiveness ratio of 18,357.18 €/QALY gained whereas the inclusion of indirect cost and accident cost produced reductions of the ICER to € 14,609.51 and € 15,515.26 per QALY, respectively. Finally, all results in the sensitivity analysis are below the lower bound of national and international cost- effective threshold.CONCLUSION: Thyrogen® represents a cost-effective option for patients with differentiated thyroid cancer who underwent total or near-total thyroidectomy in Italy. Our findings are consistent with other cost-utility analyses.

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Reversible Cognitive, Motor, and Driving Impairments in Severe Hypothyroidism

Cited by 36 publications

References 31 publications

Daytime somnolence as an early sign of cognitive decline in a community‐based study of older people

Daytime somnolence as an early sign of cognitive decline in a community‐based study of older people

Regional Variation across Canadian Centers in Radioiodine Administration for Thyroid Remnant Ablation in Well-Differentiated Thyroid Cancer Diagnosed in 2000–2010

Cost-effectiveness profile, organizational implications and patient preferences on the use of exogenous TSH therapy (Thyrogen®) vs. THW in thyroid residue ablation in Italy

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